Dear Editor,We have read the article by Londhe et al. [1] entitled “Study of patients with bilateral knee osteoarthritis undergoing total knee replacement procedure with coexisting lumbar spondylosis symptoms” with great interest and congratulate the authors for this thought-provoking topic; however, there are a few queries that need to be addressed:1. How did you prevent the possible confounding of the Oswestry Disability Index (ODI) by knee osteoarthritis pain [2]?2. ODI was moderate to severe preoperatively in all patients, then why was spine not addressed first? How did the ODI decrease after total knee replacement?3. Was any correlation between ODI and Oxford Knee Score checked?4. How was the possible selection bias towards advanced osteoarthritis as compared to lumbar spine degeneration addressed in the study?5. Is it possible that the incidental finding of lumbar degeneration lead to better scrutiny and treatment of spine symptoms in these patients [3]?